Provider Demographics
NPI:1497245062
Name:RALEY, CHRISTOPHER PATRICK
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:RALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 LEGEND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1267
Mailing Address - Country:US
Mailing Address - Phone:513-502-7219
Mailing Address - Fax:
Practice Address - Street 1:2123 AUBURN AVE STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-206-1170
Practice Address - Fax:513-206-1172
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.308327163W00000X
OHRN308327163W00000X
OHCNP.023425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307916Medicaid